Question #1:
>Hi!
>Will you please enlighten me on the difference between primary rhinoplasty
and total rhinoplasty?
>Thanks a great deal.
An Answer:
Primary rhinoplasty refers to the first operation on a particular patient's
nose. Total rhinoplasty may refer to rhinoplasty combined with work on
the nasal septum (septoplasty). I have not seen this latter term used often.
Thanks for the Question,
John Di Saia, M.D.
Question #2:
>I am a 27 year old male in New York City and I am highly considering
rhinoplasty over the next month. I have a few questions I was hoping you
could help me with.
>
> - how many procedures per week or year should the surgeon be performing
to be considered very competant (in your opinion)?
> - I've read that patients that undergo rhinoplasty are 10 times more
likely to fracture their noses? Is this accurate and just an accepted risk
by those that undergo the procedure?
> - What percentage (approximately) of the under 40 population regret
getting this surgery done? Are most fairly happy with their results?
> - Other than fracturing the nose again are their any other risks
associated with this surgery?
> - I've heard that the typical rhinoplasty can be performed in about
40 minutes and is done as an outpatient...does this sound accurate?
>
>Any other comments especially about choosing a physician or hospital
or anything else would be very much appreciated. Thank you so much.
An Answer:
I would preface this answer with a commonly appreciated fact...rhinoplasty can be a very difficult operation. The shape of a person's nose is a very sensitive item. Sometimes providing the patients with a textbook result will be looked upon as a poor result in the eyes of the patient.
Rhinoplasty can almost always be performed as an outpatient. The main risks of the procedure are dependent upon what is exactly done. Deviations of the septum can persist. Hematomas can form but very rarely require re-operation. Infection is almost never seen.
On the number of procedures per week, it is probably not a fair estimation of the quality of the surgeon. Each rhinoplasty is a bit different. Not everyone needs every aspect of their nose surgically addressed. Some need a little tip work and others just a reduction of the nasal "hump." There is no "typical" rhinoplasty. Some may take less than an hour and others may take several hours. A few of the best nasal surgeons I know may not do a rhinoplasty for a month or more and then may do three or four. Referral patterns more often determine the types of cases a surgeon will perform at any given time.
With regards to fracture, I have not heard your statistic before. I have certainly not read it in any reputable journal, so I would be inclined to say it is not established.
For the same reasons, it is difficult to provide statistics as to how many people are happy with their results. This often has more to do with the surgeon's ability to communicate pre-operatively with the patient. Expectations particularly in this type of surgery are very important.
Choosing a surgeon is probably the patient's most difficult task. Determining
the skill of the surgeon you have before you is really a guessing game.
Things that can help include a referral from a doctor or previous patient.
Pictures of previous patients can help too. A very important item is your
ability to interact with your doctor. You should feel comfortable with
your surgeon and the procedure before you get to the operating room.
Thanks for the question,
John Di Saia, M.D.
Question #3:
>Dear Dr. Di Saia:
I have been interested in breast implants for several years and very
much would like to have them now, but am resigned to holding out until
the FDA study (randomly sampling of about 500,000 women w/breast augmentation)
comes out sometime in 1998. Meanwhile, I continue to try to find out everything
I can about the pros and cons. I would greatly appreciate your input on
the following questions:
>1) Does sub-muscular placement of saline implants permanently weaken/damage
the pectoralis major muscle? If so, to what degree (i.e., will one notice
a marked difference in their strength)?
>2) What causes the "rippling" effect of the skin surface from saline
implants? What is the chance of it happening? And, once it appears, can
it disappear again?
>3) After doing a literature search on breast augmentation, I noticed
a paucity of information on saline implants (probably becuase silicone
implants are the hot issue right now). Are all saline implants currently
on the market encased in silicone? And, if so, are there any indications
that the silicone casing causes problems similiar to liquid silicone?
>Thank you very much for taking time to answer my many questions.
An Answer:
Breast Implants placed beneath the Pectoralis muscle do indeed lead to weakening of the muscle. The pressure from the implants is thought to cause atrophy of the muscle. Fortunately, this is rarely of significance. It is however worth a mention to serious weight lifters or other athletic enthusiasts.
The "rippling effect" you mention occurs with saline implants because water is so fluid. Silicone implants didn't do this because the properties of the gel wouldn't allow it physically. The appearance on the breast surface indicates that the implant has folded and the breast tissue above it is thin. It can appear and disappear, but I wouldn't be able to quote your statistics. This is why many plastic surgeons (like myself) place breast implants behind the pectoralis muscle in nearly all cases.
All breast implants of which I am aware have a silicone elastomer shell.
There has been no evidence of problems with this shell of which I know.
Thanks for the question,
John Di Saia, M.D.
Question #4:
>Hi Dr Di Saia,
>I was very happy to find your Web Site! I am currently scheduled to
undergo breast augmentation surgery on August 19th. I am in Northern CA,
and my surgeon here recently started doing the belly button approach.
>He says that I am a good candidate for this approach, as I have some breast tissue. (I am a small B cup).
>I have been trying to find information on this type of augmentation, but cannot find much. I saw the man who invented the procedure on the Donohue show several years ago. I know that there are not many surgeons who do it, and my surgeon is the first in Northern CA that I know of who is performing it.
>What information can you give me about this procedure? Any information that you have would be extremely helpful to me.
An Answer:
I understand the attraction to the procedure. After all, there are no scars on the breast. I have seen the procedure presented at a local meeting, but have not performed it. The problem (as I see it) is that the placement of the implant is sub-glandular (not behind the pectoralis muscle). The long term results with this technique using saline implants at best would be equivalent to those of other sub-glandular techniques.
Without the pectoralis muscle as padding, saline implants don't tend
to look so good with time. There can be wrinkling evident at the surface
of the breast which seems more common without the muscle as cover. It can
happen with a submuscular placement but is far less common. Apparently,
your surgeon has considered this as (according to your letter) he states
your breast tissue makes you a good candidate. I have seen no studies with
results of this procedure any farther post-operatively than a year.
Thanks for the question,
John Di Saia, M.D.
Question #5:
>I am a Black female in my early 30s considering liposuction. Most of my fat is in the lower and upper portion of my stomach area. Because of this I wear a minimum of 1 size larger than needed. I have crunched and walked my way to oblivion to no avail. I have read quite a bit of documentation on the web pertaining to this subject; but nothing geared or directed at Black Women. Are there any special concerns that I need to be aware of? Do you know of any Doctors that specialize in or are very knowledgable in Black skin.
An Answer:
As liposuction is not directed at the skin, but rather fat, your skin
is not of primary concern. The increased tendency for African Americans
to form keloid scarring pertains to any operation including liposuction.
The incisions used in liposuction are fortunately small and should be placed
in inconspicious areas. Poor scars can form in any operative procedure.
Thanks for the question,
John Di Saia, M.D.
Question#6:
>Hi!
>
>My name is Melodi. I have been considering three different surgeries
and was wondering if they could all be done at one time, instead of three
different trips to the doctor. I would like to have Liposuction on my thighs
and buttocks, a mini tummy tuck, and a breast augmentation.
An Answer:
Have you spoken with a surgeon? Sometimes a "mini abdominoplasty" can do the job and other times it only addresses half of the problem. Make sure that the changes you seek are possible with these procedures first.
Second, some surgeons would perform all these procedures at once (if
your medical status were good). Surgeons take varying amounts of time to
do the same procedure. What one feels he or she can do in an hour may take
another three. That's not to say the result will be necessarily different.
Breast augmentation (without mastopexy) takes me a hour to an hour and
a quarter. Liposuction can take anywhere from thirty minutes to three hours
(it depends upon the nature of the job). A "mini-abdominoplasty" takes
about two hours. These are my averages. So it is conceivable that the procedures
could be done with the same anesthetic.
Thanks for the question,
John Di Saia, M.D.
Question #7:
>I am a 26-year old female interested in Liposuction. I am in Miami,
Florida.
>I would like to know a little bit more about Liposuction; for instance:
is it really painful? How long is the recovery time? Are there any risks
involved? Are the results really noticeable?
>I weight 148LBS and most of weight is concentrated in my abdomen.
I don't know whom to contact, who is qualified to do this procedure with
the highest sucessfull rate and no risks involved.
An Answer:
You ask a number of difficult questions.
Is liposuction painful? To an extent everyone has discomfort associated with the procedure. People have differing pain tolerance though. some of my patients have thought it was nothing and others were more uncomfortable. No one I have treated has required more than oral pain medications.
Recovery time? Most people are back to work within a week (depending of course upon their occupation). Light secretarial work can be performed within days of the average pilosuction. Take into account that depending upon the amount of work done, disability and pain will vary.
Risks involved? Any time surgery is performed there are risks involved. Anyone that tells you otherwise is "candy-coating" it. Fortunately, with liposuction problems are infrequent. The most frequent complaint is contour irregularity requiring more liposuction. As many as 30% of patients will come back for "touch ups." It is difficult to predict reliably how portions of the body will look when all the swelling comes down (during and after the procedure). What one is really trying to do here is anticipate how someone will heal. Other problems include seromas (fluid collections) which may require drainage. Everyone gets bruising which again varies in quality. Some people bruise more than others. The patients can help here however by avoiding aspirin, ibuprofen and other such medications as these contribute to bleeding (and therefore bruising).
Are the results noticeable? Expectation is very important here.
Some people expect the world, others less. Remember that liposuction is
an operation of contour. You are not going to be "re-invented" here. Most
people who are operated upon for the right reasons seem happy with the
results.
Thanks for the question,
John Di Saia, M.D.
Question #8:
>A question concerning breast augmentation as I am considering having
the procedure; Is it possible to return to work a week post surgery?
Thanks
An Answer:
This depends entirely upon what you do for a living. I tell people common
sense prevails here. You are going to be restricted from vigorous activity
for a few weeks. Earlier activity may cause the implants to migrate. Light
secretarial activity is certainly conceivable as soon as two to three days
after surgery. I usually encourage people with these "light duty" types
of jobs to stay off a week or so.
Thanks for the question,
John Di Saia, M.D.
Question #9:
>Hello. I have a question for you. I am a 26 year old female and I have dark circles under my eyes all of the time, even when I have had plenty of sleep. I have noticed this about myself since I was very young. I remember being teased about it as early as sixth grade.
> What causes this and what can be done to fix it. Otherwise my skin is great not saggy or anything.
An Answer:
The reason here is more likely than not genetics. There are a number
of bleaching creams that you can try. They are by prescription however.
I get these circles myself (although I haven't treated them).
Thanks for the question,
John Di Saia, M.D.
Question #10:
>I have puffy lower eyelids, always look tired and take bad photos.
>
>Any idea what the surgery to correct this entails?
>
>It would be nice to look energetic when I feel fine!
An Answer:
The surgery when "puffiness" is present is blepharoplasty. In your case
(you specify the lower lids), it may be performed as lower lid blepharoplasty.
The incision can be made in several places depending upon the goals of
surgery (which depends upon your physical exam). There are three pockets
of fat in the lower eyelid which should be explored. Excess fat is removed
from these areas. Sometimes a skin excision is necessary. The surgery is
performed as an outpatient. Patients can return to work quickly (a few
days to a week), although swelling/bruising can take a few weeks to entirely
resolve.
Thanks for the question,
John Di Saia, M.D.
